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Tuesday, May 3, 2016

AMRM Training Solutions : Knowledge Test and Discussion Builder.

Feel free to use this test in your safety training sessions, or crew briefings. You may copy and paste, and add or subtract material as desired. We ask that you credit AMRM Training Solutions in your final product. We think the answers should be self-evident; but if you would like to discuss our ideas about the correct answers, leave a comment.

Safety Day – AMRM Training

Created by:

AMRM Training Solutions

Name:

Results:

Class:

Air Medical Resource Management

Period:

AM
PM

Date:

Please read each question carefully and circle what you
think is the best answer. Some of these questions are purposely designed to
foster discussion and interpretation.

1.According to the Federal Aviation
Administration, what percentage of aviation accidents are attributable to human
error?

a.40% to 50%

b.70% to 80%

c.100%

2.In
what way does Air Medical Resource Management Training differ from Crew
Resource Management Training?

a.CRM training was originally intended for the
major airlines, and more recently has been required for part-135 air carriers
as well. CRM is required for everyone on board our helicopters. AMRM training
is only pertinent to medical flight team members.

b.CRM training is more important than AMRM training
and carries the weight of law, as it is required by the FAA. AMRM training is
voluntary and is designed to make medical flight team members “feel good.”

c.CRM training is only required for the pilot –
the only FAA-acknowledged “crew.” AMRM training is intended for all persons
involved with Helicopter Air Ambulances. CRM training is required by
regulation. AMRM training is recommended by advisory circular and required for
CAMTS certification.

3. As no policy, procedure, or protocol can cover
every eventuality for operations in
naturalistic environments, what are the three major considerations for decision
making, in order of importance, in the absence of other guidance?

a.Company, Safety, Patient

b.Patient, Safety, Company

c.Safety, Patient, Company

4. (Non-clinicians, pilots etc., for the purposes
of this question, put yourself in the role of medical flight team member : the purpose of this question is to spark
thought and discussion, and your response may be subject to program
factors/protocols) You are on scene with your helicopter, picking up a victim of
trauma. The pilot advises that “you need to hurry, as a thunderstorm is
rapidly approaching your planned destination – receiving hospital.” As you hear
this call come over the radio, you are in the back of an ambulance preparing to
intubate. What is your response?

a.You respond to the pilot, “okay, we are getting
ready to tube this guy, we will hurry up and be right with you. Keep the
aircraft running!”

b.You ask the pilot to coordinate with your com-
center on other possible hospitals for the patient, advising him that you are
preparing to intubate and may be delayed. You are aware that other destination
hospitals may not have all the capabilities and resources that your primary
destination had, for example level 2 trauma center status.

c.You tell the pilot that you will be proceeding
inbound by ground to your primary destination, and he is clear to depart
immediately. You are aware that this will create a significant delay in the
patient’s arrival to definitive care – but this is your protocol.

d.You would not select any of these options.
Instead you would opt to :

5. You were requested for an inter-facility
transport from a distant hospital. While enroute and after an extended period
of flight, you were cancelled due to the patient expiring. While returning to
your base, you are requested for another transport. You perform a quick check of your fuel state
and the fuel required, and verify weather.
Then, after conferring with the crew, you accept the flight. Your ground
time at the scene - an MVA on an interstate highway which was shut down for
your landing - was extended due to prolonged extrication. Now, in-flight under
visual flight rules and with an increasing headwind - and with a patient on
board - you realize that your fuel state is lower than you had expected it to
be. You determine that you can either; reach your destination with 5 minutes of
fuel remaining, you can reach an enroute fuel stop with 10 minutes of fuel
remaining, or you can land at a nearby hospital helipad immediately with 20
minutes of fuel remaining. After conferring amongst yourselves on board the
aircraft you decide to:

a.Continue on to the original destination.

b.Proceed to the enroute fuel stop.

c.Land at the nearby hospital helipad.

6. The medical flight team members have the
authority and responsibility to speak up when they are concerned about safety
of flight operations.

a.This is a true statement.

b.This is not a true statement. As stated in the FARs, the pilot is the final
authority when it comes to flight operations, and his or her decisions are
final.

c.This is a true statement, but the flight team
must be aware that the timing of - and the manner in which - questions are
asked and statements are made can affect responses and outcomes.

7. One of the hazardous attitudes covered in
class was judged to be the most insidious and dangerous to HAA flight teams by
the AMRM instructor. It was…

a.Invulnerability. A pilot with thousands of hours
of experience judges herself to be impervious to any sort of adverse events.

b.Anti-authority. As HAA pilots are largely
self-reliant “lone-rangers”, and are frequently forced to improvise, adapt, and
overcome in order to get the job done - over time they tend to bypass rules and approved-procedures in favor of
techniques that work for them personally.

c.Get-home-it is. This is the most dangerous of
all hazardous attitudes in HAA operations because, at the end of the day, we all want to get back to our base. We
accept risk as a group.

8. There is a known positive-correlation between
experience-levels and the quality of decision-making. A more experienced leader
or team-member has been shown by research to always make better choices.

a.True. Intuitively we understand that experience
improves understanding and the ability to make good decisions. A more
experienced team is always going to perform better in a challenging
environment, and there is no reason for an experienced leader or team member to
include new team-members in the decision-making process. A new team member need
never question the decisions of an experienced leader.

b.False.
Research has shown that decision-makers don’t always make better choices with
more experience. Because of the demands of a naturalistic environment, the use
of heuristics (rules-of-thumb), and choices that satisfy/suffice (satisfice) in
a time-critical, high-consequence environment, experience does not always equal the best decision.

9. Any member of our team may provide a solution
to a problem, or help prevent a mishap or adverse outcome.

a.True, even a non-aviator can provide life-saving
information and assistance.

b.False. A pilot has no business making any
observations whatsoever regarding a patient’s condition or care.

10. Conducting Helicopter Air Ambulance flight
operations is inherently dangerous, and I must accept that such danger is part
of the job. I don’t concern myself with “what will be.” I leave my fate to
chance and hope. I know that inevitably, some number of HAA crews will be
killed each year and nothing can be done to change this.

a.This is an example of realistic thinking. Good
for you. You are pragmatic enough to accept what history has repeatedly shown
to be true.

b.This is a classic example of the manifestation
of the hazardous attitude known as “resignation.” I can indeed influence my fate, by adhering to the tenets of AMRM and by being
an all-in member of this flight team.

c.As a medical flight team member, I don’t know
enough about flight operations to ask questions, and I don’t feel comfortable
requesting education about the flying side of HAA operations.

d.As a pilot, I understand that “fate is the
hunter,” as explained by famous aviation writer Earnest K. Gann. No matter how
much I prepare, no matter how thorough and dedicated to my craft I am, I must
accept the fact that a mishap is a real possibility. Since I cannot eliminate
risk, I will not concern myself with it.

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About Me

I am a retired army aviator, and flew EMS helicopters from 1999 until 2015. I have flown at many different programs under traditional, community based, and hybrid models. I enjoy interacting with crewmembers as we together learn how to avoid becoming a statistic and the topic of someone else's safety brief. I teach Air Medical Resource Management, and am a member of the National EMS Pilot's Association's board of directors.